Get Started!

To find out more about National PT and how to get started with your own physician-owned PT clinic, please complete the form below to the best of your ability. The more information you can provide — the better we can fulfill your request for information. Alternatively, you may contact us at 312.214.4948 or e-mail info@nationalpt.com.

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Last Name:
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State:	Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
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How many physicians in this group refer patients for Physical Therapy?
How many Physical Therapy referrals does your practice average per month?
List each physician by Specialty (and location, if applicable) and associated Physical Therapy referrals.
How many locations exist for this practice?
If you have multiple locations, please list where each office is located and the distance (time and miles) between each office.
Where are patients currently being referred to for Physical Therapy?
What is the current patient/payor mix of the practice's patients being referred to Physical Therapy? Assign a percentage to each of the following:
Medicare Blue Cross Commercial HMO Medicaid Auto Workers Comp Other
Please fill out the section below IF APPLICABLE TO YOUR PRACTICE.
How many total surgical procedures were performed by the physician(s) in the most recent 4 week timeframe?
During the same 4 week timeframe, what was the total number of patient visits?
Additional comments, questions: